‘Sicko,’ Castro and the ‘120 Years Club’

By ANTHONY DePALMA

CUBA works hard to jam American TV signals and keep out decadent Hollywood films. But it’s a good bet that Fidel Castro’s government will turn a blind eye to bootleg copies of “Sicko,” Michael Moore’s newest movie, if they show up on the streets of Havana.

“Sicko,” the talk of the Cannes Film Festival last week, savages the American health care system — and along the way extols Cuba’s system as the neatest thing since the white linen guayabera.

Mr. Moore transports a handful of sick Americans to Cuba for treatment in the course of the film, which is scheduled to open in the United States next month, and he is apparently dumbfounded that they could get there what they couldn’t get here.

“There’s a reason Cubans live on average longer than we do,” he told Time magazine. “I’m not trumpeting Castro or his regime. I just want to say to fellow Americans, ‘C’mon, we’re the United States. If they can do this, we can do it.’ ”

But hold on. Do they do it? Live longer than, or even as long as, we do? How could a poor developing country — where annual health care spending averages just $230 a person compared with $6,096 in the United States — come anywhere near matching the richest country in the world?

Statistics from the World Health Organization, the C.I.A. and other sources all show that the people of Cuba and the United States have about the same life expectancy — 77 years, give or take a few months — while infant mortality in Cuba is significantly lower than in the United States.

Of course, many people regard any figures about Cuba as at least partly fiction. But even if the longevity statistics are correct, they are open to interpretation. Carmelo Mesa-Lago, a professor emeritus of economics at the University of Pittsburgh, said statistics also show that Cuba has a high rate of abortion, which can lower infant mortality rates and improve life expectancy figures. The constant flow of refugees also may affect longevity figures, since those births are recorded but the deaths are not.

Despite such skepticism, many medical experts say they do believe that average Cubans can live as long as Americans, and the reason may lie in a combination of what Cuba does well and the United States does poorly, if at all.

Dr. Robert N. Butler, president of the International Longevity Center in New York and a Pulitzer Prize-winning author on aging, has traveled to Cuba to see firsthand how doctors are trained. He said a principal reason that some health standards in Cuba approach the high American level is that the Cuban system emphasizes early intervention. Clinic visits are free, and the focus is on preventing disease rather than treating it.

Dr. Butler said some of Cuba’s shortcomings may actually improve its health profile. “Because they don’t have up-to-date cars, they tend to have to exercise more by walking,” he said. “And they may not have a surfeit of food, which keeps them from problems like obesity, but they’re not starving, either.”

Cuban markets are not always well stocked, but city streets are dotted with hot dog and ice cream vendors. Bellies are full, but such food can cause problems in the future, as it has in the United States.

Dr. Butler has just completed a study that shows it is possible that because of the epidemic of obesity in children, “this may be the first generation of Americans to live less long than their parents.”

There could be one great leveler for Cubans and Americans. While all Cubans have at least minimal free access to doctors, more than 45 million Americans lack basic health insurance. Many are reluctant to seek early treatment they cannot afford, Dr. Butler said. Instead, they wait to be admitted to an emergency room.

“I know Americans tend to be skeptical,” he said, “but health and education are two achievements of the Cuban revolution, and they deserve some credit despite the government’s poor record on human rights.”

Universal health care has long given the Cuban regime bragging rights, though there is growing concern about the future. In the decades that Cuba drew financial and military support from the Soviet Union, Mr. Castro poured resources into medical education, creating the largest medical school in Latin America and turning out thousands of doctors to practice around the world.

But that changed after the collapse of the Soviets, according to Cuban defectors like Dr. Leonel Cordova. By the time Dr. Cordova started practicing in 1992, equipment and drugs were already becoming scarce. He said he was assigned to a four-block neighborhood in Havana Province where he was supposed to care for about 600 people.

“But even if I diagnosed something simple like bronchitis,” he said, “I couldn’t write a prescription for antibiotics, because there were none.”

He defected in 2000 while on a medical mission in Zimbabwe and made his way to the United States. He is now an urgent-care physician at Baptist Hospital in Miami.

Having practiced medicine in both Cuba and the United States, Dr. Cordova has an unusual perspective for comparison.

“Actually there are three systems,” Dr. Cordova said, because Cuba has two: one is for party officials and foreigners like those Mr. Moore brought to Havana. “It is as good as this one here, with all the resources, the best doctors, the best medicines, and nobody pays a cent,” he said.

But for the 11 million ordinary Cubans, hospitals are often ill equipped and patients “have to bring their own food, soap, sheets — they have to bring everything.” And up to 20,000 Cuban doctors may be working in Venezuela, creating a shortage in Cuba.

Still Cuban officials assert that free health care, a variety of sports programs, a healthy, if limited, diet and cultural activities have kept enough Cubans healthy enough well into old age to warrant starting the 120 Years Club, which enrolls people who are 80 and older and strives to help them reach an even riper old age.

Until he had to have emergency surgery last year, Fidel Castro — who turned 80 this year — was considered a model of vibrant long life in Cuba. But it was only last week that he acknowledged in an open letter that his initial surgery by Cuban doctors had been botched. He did not confirm, however, that a specialist had been flown in from Spain last December to help set things right.